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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 228 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-8147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A.M. <br /> <br /> I am performing work on aproperty I own or occupy, <br /> I am a registered builde~ OR ( ) the r~uthorized representative <br /> of a registered builder. <br /> The work will be performed by a registered builder, <br /> Other ................... <br /> I have read and agree to the terms stated on the reverse side of <br /> <br />DATE: 03/05/80 TIME: 9:46:01 <br /> <br /> RICKMAN, WI LLIAD1 <br /> <br />RESIDENTIAL <br /> <br /> 11595 JANES WAY DR SE <br />AU(vISVILLE OR 9?325 <br /> <br />MAILING ADDRESS: <br /> <br />~IARI ON COtJNTY NO <br /> <br />SUBDIVISION: <br /> <br />OCCUPANT LOAD: <br /> <br /> NO. OF BEDROOMS: <br /> <br /> 3 <br /> <br />11555 JANES WAY DR SE <br />AUMSVILLE OR 9?325 <br />PHONE: ?49-2430 <br /> <br />LOT: BLOCK: SECTION; TOWNSHIP: <br /> 28 <br /> <br /> 225 499 112275. <br /> <br /> SITE NUMBER= 958? <br /> VALUATION: <br /> RANge: ZONE: <br /> <br />8S tN AR <br />SF NO NO <br /> <br />MAP: <br /> <br /> 48 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 902224? <br /> <br />CONTRACTOR, NO. <br />RICKIvlAN. WILLIAM <br />11555 JAMES WAY DR SE <br />AUI'4SVILLE OR 9?325 <br />PHONE: 749-2430 <br /> <br /> WATER ~JPPLY: PW <br /> TEST HOLES READY: YES <br /> SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br />: EXISTING DRAIN FIEbB LINES~ <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOfCLS: <br /> <br /> ITEM <br />SITE EVALUATION, FIRST LOT <br /> <br />QUANTITY <br /> 1 <br /> <br /> TOTAL,,ASSES.SEDFEES <br /> PREVIOUS ,RECE[:PTS <br /> THIS RECEIPT <br /> <br /> BALANCE CUE <br /> <br />RECEIVEDBy~PAYEE: RICK+MA~o WILLIAM ~.-"~>~ TYPE..,'RECEIPTcK CHEcKNO: <br />SEE ATTACHED DOCUMENT FOR REQU~REt4ENTS'OF ,ON-SITE SEWAGE SYST~, <br /> <br />AMOUNT <br /> $175,00 <br /> <br />$175-00 <br /> $0.00 <br />$175,00 <br /> <br />$0.00 <br /> <br />23588 <br /> 2065 <br /> <br />NOTE: THIS DOES NOT ~GRANT OR IMPLY PER~4ISSION TO BUILD ON THIS PARCEL. PLANNING AND <br />CONSTRUCTION PERNII'~ ~4UST 8E OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEI~INS+ <br /> <br /> EV.E , ........ .......... CITY U*, O,OT'ION: ............................ °ATE .......................... <br />REMARKS.- S:[TE EVAL PARCEL 2 R~611 <br /> <br />FORM ~ M(: 15'56 REV li/O~ OFFICE COPY <br /> <br /> <br />